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Induced arterial hypotension for interventional thoracic aortic stent-graft placement: impact on intracranial haemodynamics and cognitive function

  • G. von Knobelsdorff (a1), R. M. Höppner (a1), P. H. Tonner (a1), A. Paris (a1), C. A. Nienaber (a2), J. Scholz (a1) and J. Schulte am Esch (a1)...


Background and objective: The study investigated the impact of induced arterial hypotension for the facilitation of endovascular stent-graft placement in patients with thoracic aortic aneurysm on cerebral blood flow velocity and neurological/neurocognitive outcome.

Methods: In 27 ASA III patients, cerebral blood flow velocity was recorded during induced arterial hypotension for endovascular stent-graft placement using transcranial Doppler sonography and the Folstein Mini Mental State Examination and the National Institute of Health Stroke Scale were performed before and after the intervention.

Results: Mean arterial pressure was decreased <50 mmHg, and in 22 patients it was <40 mmHg. Diastolic cerebral blood flow velocity decreased by 59%. Postoperatively, six of 21 patients exhibited changes in the Folstein Mini Mental State Examination and four of these six patients in the National Institute of Health Stroke Scale as indices of new-found neurocognitive dysfunction, but there were no signs of stroke. Loss of the diastolic blood flow profile was detected in two of six patients with new-found neurocognitive dysfunctions and in 18 of 21 patients with no new-found neurocognitive dysfunction. Changes in the Folstein Mini Mental State Examination on postoperative day 1 were correlated to the pre-procedural Folstein Mini Mental State Examination, but not to the time spent with a mean arterial pressure <50 mmHg, <40 mmHg or with a loss of diastolic blood flow profile.

Conclusions: Transcranial Doppler sonography visualizes the individual effect of induced hypotension and the period of intracranial circulatory arrest during aortic stent-graft placement. However, transient new-found neurocognitive dysfunctions occur independently of the transcranial Doppler data, and are in close correlation to the neurocognitive state before the procedure. The results suggest that induced arterial hypotension is not the major factor for postoperative new-found neurocognitive dysfunction.

Corresponding author
Correspondence to: Georg von Knobelsdorff, Department of Anaesthesia and Intensive Care Medicine, St Bernward Hospital, D-31134 Hildesheim, Germany. E-mail:; Tel: +49 5121 90 5424; Fax: +49 5121 90 1244
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DakeMD, KatoN, MitchellRS, et al. Endovascular stent-graft placement for the treatment of acute aortic dissection.N Engl J Med1999; 340: 15461552.

KatoN, DakeMD, MillerDC, et al. Traumatic thoracic aortic aneurysm: treatment with endovascular stent-grafts.Radiology1997; 205: 657662.

NienaberCA, FattoriR, LundG, et al. Nonsurgical reconstruction of thoracic aortic dissection by stent-graft placement.N Engl J Med1999; 340: 15391545.

DakeMD, MillerDC, SembaCP, MitchellRS, WalkerPJ, LiddellRP. Transluminal placement of endovascular stent-grafts for the treatment of descending thoracic aortic aneurysms.N Engl J Med1994; 331: 17291734.

BakerAB, BookallilMJ, LloydG. Intentional asystole during endoluminal thoracic aortic surgery without cardiopulmonary bypass.Br J Anaesth1997; 78: 444448.

FolsteinMF, FolsteinSE, McHughPR. ‘Mini-mental state’ a practical method for grading the cognitive state of patients for the clinician.J Psychiatr Res1975; 12: 189198.

TombaughTN, McIntyreNJ. The mini-mental state examination: a comprehensive review.J Am Geriatr Soc1992; 40: 922935.

GraceJ, NadlerJD, WhiteDA, et al. Folstein vs modified mini-mental-state examination in geriatric stroke.Arch Neurol1995; 52: 477484.

WitykRJ, PessinMS, KaplanRF, CaplanLR. Serial assessment of acute stroke using the NIH stroke scale.Stroke1994; 25: 362365.

BiedlerA, JuckenhöfelS, LarsenR, et al. Postoperative Störungen der kognitiven Leistungsfähigkeit bei älteren Patienten.Anaesthesist1999; 48: 884895.

RoachGW, KanchugerM, Mora-ManganoC, et al. Adverse cerebral outcomes after coronary bypass surgery.N Engl J Med1996; 335: 18571863.

MitchellRS, DakeMD, SembaCP, et al. Endovascular stent-graft repair of thoracic aortic aneurysms.J Thoracic Cardiovasc Surg1996; 111: 10541062.

AlbaneseMA, ClarkeWR, AdamsHP, WoolsonRF, TOAST investigators. Ensuring reliability of outcome measures in multicenter clinical trials of treatments for acute ischemic stroke.Stroke1994; 25: 17461751.

ShawPJ, BatesD, CartlidgeNE, et al. Neurologic and neuropsychological morbidity following major surgery: comparison of coronary artery bypass and peripheral vascular surgery.Stroke1987; 18: 700707.

MurkinJM, MartzkeJS, BuchanAM, BentleyC, WongCJ. A randomized study of the influence of perfusion technique and pH management strategy in 316 patients undergoing coronary artery bypass surgery: (part II) neurologic and cognitive outcomes.J Thorac Cardiovasc Surg1995; 110: 349362.

DahlA, RusselD, Nyberg-HansenR, RootweltK. Effect of nitroglycerin on cerebral circulation measured by transcranial Doppler and SPECT.Stroke1989; 20: 17331736.

WernerC, HoffmanWE, KochE, AlbrechtRF, Schulte am EschJ. Transcranial Doppler sonography indicates critical brain perfusion during hemorrhagic hypotension in dogs.Anesth Analg1995; 81: 12031207.

LamAM. Change in cerebral blood flow velocity pattern during induced hypotension: a non-invasive indicator of increased intracranial pressure?Br J Anaesth1992; 68: 424428.

WheatMW. Current status of medical therapy of acute dissecting aneurysms of the aorta.World J Surg1980; 4: 563569.

KahnRA, MarinML, HollierL, ParsonsR, GrieppR. Induction of ventricular fibrillation to facilitate endovascular stent-graft repair of thoracic aortic aneurysms.Anesthesiology1998; 88: 534536.

WeigandMA, MotschJ, BardenheuerHJ, KahnRA, MarinML, HollierLH. Adenosine-induced transient cardiac arrest for placement of endovascular stent-grafts in the thoracic aorta.Anesthesiology1998; 89: 1037.

WiegandMA, SchumacherH, AllenbergJR, BardenheuerHJ. Adenosin-induzierter Herzstillstand zur endovasculären Rekonstruktion von thorakalen Aortenaneurysmen.Anästhesiol Intensivmed Notfallmed Schmerzther1999; 34: 372375.

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European Journal of Anaesthesiology
  • ISSN: 0265-0215
  • EISSN: 1365-2346
  • URL: /core/journals/european-journal-of-anaesthesiology
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